<?php
include_once("codelibrary/inc/variables.php");
include_once("codelibrary/inc/functions.php");
?>
<!doctype html public "-//W3C//DTD HTML 4.01 Transitional//EN">
<html dir="LTR" lang="en"><!-- InstanceBegin template="/Templates/tmp1.dwt.php" codeOutsideHTMLIsLocked="false" -->

<head>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">

<title>Free Trial - Online Appointment</title>
<script type="text/javascript" src="codelibrary/js/common.Js"></script>
<script type="text/javascript">
function submitform()
{
 
	if(ValidateForm(document.loginForm))
	{
	    return true;
	}
	else
	{
	    return false;
	}
}
</script>

<base >
<link rel="stylesheet" type="text/css" href="stylesheet.css">
<title>Staff Management</title>
<script type="text/javascript" src="codelibrary/js/common.Js"></script>
<script type="text/javascript">
function submitform()
{
 
	if(ValidateForm(document.loginForm))
	{
	    return true;
	}
	else
	{
	    return false;
	}
}
</script>

<style type="text/css">
<!--
.style1 {
	color: #FFFFFF;
	font-weight: bold;
}
-->
</style>
</head>
<body marginwidth="0" marginheight="0" topmargin="0" bottommargin="0" leftmargin="0" rightmargin="0" onload=document.loginForm.TR_User_Name.focus();>




<table cellpadding="0" cellspacing="0" border="0"><tr>
  <td bgcolor="#FF9B14" style="background:url(images/top.gif) repeat-x top; ">
    <table cellpadding="0" cellspacing="0" border="0" style="width:764px" align="center"> 
	<tr>
		<td>
			<table cellpadding="0" cellspacing="0" border="0" style="height:57">
				<tr>
					<td height="46">
						<table cellpadding="0" cellspacing="0" border="0" style="height:3 ">
							<tr>
							  <td height="3" bgcolor="#2A2A2A"><a href="home.php"><img src="images/mm.gif" border="0" alt="" width="147" height="25"></a><br></td>
							  <td align="center" bgcolor="#2A2A2A"><a href="#"><span class="style1">Help</span></a></td>
							  <td align="center" bgcolor="#2A2A2A"><a href="#"><span class="style1">Support</span></a></td>
							  <td bgcolor="#2A2A2A">&nbsp;</td>
							</tr>
						</table>
				  </td>
				</tr>
			</table>


		</td>
	</tr>
	<tr>
		<td>





<table border="0" width="100%" cellspacing="0" cellpadding="0">
  <tr>
    <td valign="top" class="col_left">

<table border="0"cellspacing="0" cellpadding="0" class="box_width_left">
	<tr><td width="100%">
		<table border="0" cellspacing="0" cellpadding="0">
<tr><td>

<table border="0" width="100%" cellspacing="0" cellpadding="0" class="">
  <tr>
    <td>
    <table border="0" width="100%" cellspacing="0" cellpadding="0"  class="" height="91">
  <tr>
    <td align="center" height="91">
    <img border="0" src="images/logo.jpg" width="208" height="86"></td>
  </tr>
</table>
</td>
  </tr>
</table>
</td></tr>


          <tr>
            <td>
<table border="0" width="100%" cellspacing="0" cellpadding="0"  class="box_header_txt" height="48">
  <tr>
    <td style="background-image: url(images/1_bg2-2.gif)" height="1">
      <p style="margin-top: 16"></td>
  </tr>
</table>
<table border="0" width="100%" cellspacing="0" cellpadding="0"   style="border-bottom:12px solid #ffffff;">
  <tr>
    <td>
    <table border="0" width="100%" cellspacing="0" cellpadding="0"  style="margin-bottom:0px;background:#FF6A21 url(images/1_line.gif) no-repeat left bottom;" class="box_body">
  <tr>
    <td  style="padding:3px 16px 8px 25px;"><p>&nbsp;</p>
      <p>&nbsp;</p>
      <p>&nbsp;</p>
      <p>&nbsp;</p>
      <p>&nbsp;</p>
      <p>&nbsp;</p>
      <p>&nbsp;</p>
      <p>&nbsp;</p>
      <p>&nbsp;</p>
      <p>&nbsp;</p>
      </td>
  </tr>
</table>
</td>
  </tr>
</table>
            </td>
          </tr>


          <tr>
            <td class="">&nbsp;
</td>
          </tr>

		</table>
	</td>
	<td><img src="images/spacer.gif" border="0" alt="" width="15" height="1"></td></tr>
</table>

    </td>

    <td width="100%" valign="top">
<table border="0" width="100%" cellspacing="0" cellpadding="0"  class="cont_header_txt">
  <tr>
    <td>
			<table cellpadding="0" cellspacing="0" border="0" class="cont_header_txt">
				<tr>
					<td><img src="images/1_q1.gif" border="0" alt="" width="45" height="39"></td>
					<td style="width:100%">><!-- InstanceBeginEditable name="EditRegion3" -->WELCOME to online appointment manager</td>
					<td><img src="images/1_q2.gif" border="0" alt="" width="10" height="39"></td>
				</tr>
			</table>										 
			</td>
  </tr>
</table>


						<table cellpadding="0" cellspacing="0" border="0" style="border:0px solid #DEDEDE; border-width:0px 1px 0px 1px;">
							<tr><td style="background:#ffffff;border:0px solid #ffffff; border-width:18px 5px 10px 5px;">
		                        <!-- new_products //-->
	                            
								<form name="loginForm" action="free-trial-submit.php" 
method=post onSubmit="return submitform();">
  <table border="0" width="" cellspacing="0" cellpadding="0" class="box_width_cont product">
   <tr>
    <td><table width="95%" border="0" align="center" cellpadding="3" cellspacing="0" >
          <tr>
            <td colspan="2"></td>
          </tr>
          <tr>
            <td colspan="2"></td>
          </tr>
		  <tr>
            <td colspan="2" class="header-txt">Free 30 Day Trial Enrollment </td>
            </tr>
          <tr>
		  <tr>
            <td colspan="2">&nbsp;</td>
          </tr>
          <tr>
            <td colspan="2" class="header-txt">Important : </td>
            </tr>
          <tr>
            <td colspan="2" >&nbsp;- We will never sell or share any information  you provide.<br>
- It is <strong>not</strong> necessary to enter credit card information to sign up for  the free trial.<br>
<br>
Immediately after you complete the following information, you may start setting  up your site. You will also receive a confirmation e-mail.</td>
            </tr>
          <tr>
            <td colspan="2" >&nbsp;</td>
          </tr>
          <tr>
            <td colspan="2" align="left"><strong>Company Information</strong></td>
            </tr>
          <tr>
            <td colspan="2" align="left" >(Required Fields Are In Bold)</td>
            </tr>
			<tr>
            <td colspan="2" >&nbsp;</td>
          </tr>
          <tr>
            <td width="47%" align="right" >&nbsp;&nbsp;<strong>Type Of Business </strong>&nbsp;:&nbsp;&nbsp;&nbsp; </td>
            <td  align="left">
			<SELECT name="TR_BusinessCategory">
                        <?php

						foreach($array_business_category as $key=>$value)
						{
									  
						?>
							<OPTION <? if($key!=0){?> value="<?=$key;?>" <? }?> <? if(isset($TR_BusinessCategory) && $TR_BusinessCategory==$key){echo "selected";}?>>
							<?=$value;?>
							</OPTION>
                        <?php
						}
						?>
                      </SELECT>
					  </td>
          </tr>
          <tr>
            <td align="right" >&nbsp;&nbsp;<strong>Name of Company </strong>&nbsp;&nbsp;:&nbsp;&nbsp;&nbsp;</td>
            <td>
			    <INPUT name="TR_Company" type="TEXT" value="<? if(isset($TR_Company))echo $TR_Company;?>">        
			</td>
           </tr>
		   <tr>
            <td align="right" >&nbsp;<strong>Contact First Name </strong>&nbsp;&nbsp;:&nbsp;&nbsp;&nbsp;</td>
            <td>
			    <INPUT name="TRFN_FirstName"  type="TEXT" value="<? if(isset($TRFN_FirstName))echo $TRFN_FirstName;?>">            
			</td>
           </tr>
		   <tr>
            <td align="right" >&nbsp;<strong>Contact Last Name </strong>&nbsp;&nbsp;:&nbsp;&nbsp;&nbsp;</td>
            <td>
			    <INPUT name="TRFN_LastName" type="TEXT" value="<? if(isset($TRFN_LastName))echo $TRFN_LastName;?>">           
			</td>
           </tr>
		   <tr>
            <td align="right" >&nbsp;&nbsp;<strong>Contact E-mail Address  </strong>&nbsp;&nbsp;:&nbsp;&nbsp;&nbsp;</td>
            <td>
			    <INPUT name="TREF_Email" type="TEXT" value="<? if(isset($TREF_Email))echo $TREF_Email;?>">            
			</td>
           </tr>
		   <tr>
            <td align="right" >&nbsp;<strong>Company Address  </strong>&nbsp;&nbsp;:&nbsp;&nbsp;&nbsp;</td>
            <td>
			   <textarea name="TR_Address" rows="3" cols="3"><? if(isset($TR_Address))echo $TR_Address;?></textarea>
			            
			</td>
           </tr>
		   
		   <tr>
            <td align="right" >&nbsp;<strong>City </strong>&nbsp;&nbsp;:&nbsp;&nbsp;&nbsp;</td>
            <td>
			    <INPUT name="TR_City"  type="TEXT" value="<? if(isset($TR_City))echo $TR_City;?>">        
			</td>
           </tr>
		   <tr>
            <td align="right" >&nbsp;<strong>State/Province</strong> &nbsp;&nbsp;:&nbsp;&nbsp;&nbsp;</td>
            <td>
			    <INPUT name="TR_State"  type="TEXT"  value="<? if(isset($TR_State))echo $TR_State;?>">            
			</td>
           </tr>
		   <tr>
            <td align="right" >&nbsp;&nbsp;<strong>Zip Postal Code </strong>&nbsp;&nbsp;:&nbsp;&nbsp;&nbsp;</td>
            <td>
			    <INPUT name="TR_Zip"  type="TEXT" value="<? if(isset($TR_Zip))echo $TR_Zip;?>">            
			</td>
           </tr>
		   <tr>
            <td align="right" >&nbsp;&nbsp;<strong>Country </strong>&nbsp;&nbsp;:&nbsp;&nbsp;&nbsp;</td>
            <td>
			    <SELECT name="TR_Country">
                                <?php

									foreach($ar_country_WI as $key=>$value)
									{
									  
								?>
								  <OPTION <? if($key!=0){ ?> value="<?=$value;?>" <? } ?> <? if(isset($TR_Country) && $TR_Country==$value){echo "selected";}?>>
								  <?=$value;?>
								  </OPTION>
								<?php
									}
							   ?>
                            </SELECT>            
			</td>
           </tr>
		   <tr>
            <td align="right" >&nbsp;<strong>Time Zone </strong>&nbsp;&nbsp;:&nbsp;&nbsp;&nbsp;</td>
            <td>
			    <SELECT name="TR_TimeZone">
                        <?php

									foreach($array_time_zone_WI as $key=>$value)
																{
																  
																?>
                        <OPTION <? if($key!=0){ ?> value="<?=$value;?>" <? } ?> <? if(isset($TR_TimeZone) && $TR_TimeZone==$value){echo "selected";}?>>
                        <?=$value;?>
                        </OPTION>
                        <?php
																}
																?>
                      </SELECT>           
			</td>
           </tr>
		   <tr>
            <td align="right" >&nbsp;<strong>Phone Number</strong>  &nbsp;&nbsp;:&nbsp;&nbsp;&nbsp;</td>
            <td>
			    <INPUT name="PHR_Phone" type="TEXT" value="<? if(isset($PHR_Phone))echo $PHR_Phone;?>">           
			</td>
           </tr>
		   <tr>
            <td align="right" >&nbsp;Alternate Phone Number  &nbsp;&nbsp;:&nbsp;&nbsp;&nbsp;</td>
            <td>
			    <INPUT name="PHN_AltPhone" type="TEXT" value="<? if(isset($PHN_AltPhone))echo $PHN_AltPhone;?>">                       
			</td>
           </tr>
		   <tr>
            <td align="right" >&nbsp;Fax Number  &nbsp;&nbsp;:&nbsp;&nbsp;&nbsp;</td>
            <td>
			    <input name="TN_Fax" type="text" id="TN_Fax" value="<? if(isset($TN_Fax))echo $TN_Fax;?>" />            
			</td>
           </tr>
		   <tr>
            <td align="right" >&nbsp;Web Address  &nbsp;&nbsp;:&nbsp;&nbsp;&nbsp;</td>
            <td>
			    <input name="TN_WebAddress" type="text" id="TN_WebAddress" value="<? if(isset($TN_WebAddress))echo $TN_WebAddress;?>" />            
			</td>
           </tr>
		   <tr>
            <td colspan="2" >&nbsp;</td>
            
           </tr>
		   <tr>
            <td colspan="2" >Use letters and numbers when creating your login and password below. The login and password you enter will be used for you to access site administration, so be sure to write these down.</td>
            
           </tr>
		   <tr>
            <td colspan="2" >&nbsp;</td>
            
           </tr>
		   <tr>
            <td align="right" >&nbsp;<strong>Enter A Login Name  </strong>&nbsp;&nbsp;:&nbsp;&nbsp;&nbsp;</td>
            <td>
			    <INPUT name="TRLEN_UserName" type="TEXT" value="<? if(isset($TRLEN_UserName))echo $TRLEN_UserName;?>">         
			</td>
           </tr>
		   <tr>
            <td align="right" >&nbsp;<strong>Enter A Password  </strong>&nbsp;&nbsp;:&nbsp;&nbsp;&nbsp;</td>
            <td>
			    <input type="password" name="TR_Password" value="<? if(isset($TR_Password))echo $TR_Password;?>">            
			</td>
           </tr>
		   <tr>
            <td align="right" >&nbsp;<strong>Retype The Password  </strong>&nbsp;&nbsp;:&nbsp;&nbsp;&nbsp;</td>
            <td>
			    <input type="password" name="TR_Confirm_Password" value="<? if(isset($TR_Confirm_Password))echo $TR_Confirm_Password;?>">          
			</td>
           </tr>
          <tr>
            <td >&nbsp;&nbsp;</td>
            <td>&nbsp;</td>
          </tr>
		  <tr>
            <td colspan="2">Clicking on the Submit button signifies your agreement to the <A 
                                href="javascript:newwindow('terms_popup.php','mywindow')">terms 
                                and conditions</A></td>
            
          </tr>
		  <tr>
            <td >&nbsp;&nbsp;</td>
            <td>&nbsp;</td>
          </tr>
          <tr>
            <td>&nbsp;</td>
            <td><input name="Submit" type="submit" class="button" value="Submit" /></td>
          </tr>
          <tr>
            <td></td>
            <td align="right">&nbsp;&nbsp;&nbsp; </td>
          </tr>
  </table>
</td>
  </tr> 	
</table>

		<table border="0" cellspacing="0" cellpadding="0" align="center" class="box_width_cont product">
          <tr><td></td></tr>
        </table>
		
 
</form>
		                      </td></tr>

						</table>
						<table cellpadding="0" cellspacing="0" border="0">
							<tr>
								<td><img src="images/1_q4.gif" border="0" alt="" width="10" height="10"></td>
								<td style="width:100%; background-image:url(images/1_li1.gif)"></td>
								<td><img src="images/1_q3.gif" border="0" alt="" width="10" height="10"></td>
							</tr>
						</table>
						


		
		
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		                <table cellpadding="0" cellspacing="0" border="0" style="height:98px; background-image:url(images/bot.gif)">
                          <tr>
                            <td><table cellpadding="0" cellspacing="0" border="0" class="footer">
                                <tr>
                                  <td><img src="images/spacer.gif" border="0" alt="" width="25" height="1"></td>
                                  <td style="width:207px"><br style="line-height:49px">
                                      <img src="images/p1.gif" border="0" alt="" width="145" height="24"><br></td>
<td style="width:532px"><br style="line-height:44px">
                                      <a href="Templates/home.php"><span><font color="#8E1214">home &nbsp; </font></span></a><br>
                                      <br style="line-height:4px">
                                    &copy; 2007<br>
                                  </td>                                </tr>
                            </table></td>
                          </tr>
                        </table></td>

    <td class="col_right">

<table border="0"cellspacing="0" cellpadding="0" class="box_width_right">
	<tr><td></td>
		<td width="100%">
			<table border="0" cellspacing="0" cellpadding="0">
				<tr><td></td></tr>
			</table>
		</td>
	</tr>
</table>


    </td>
  </tr>
</table>



		</td>
	</tr>
	<tr>
		<td>&nbsp;</td>
	</tr>
</table></td></tr></table>
<table border="0" width="100%" cellspacing="0" cellpadding="0">
  <tr>
    <td align="center"></td>
  </tr>
</table>
</body>

</html>